Pelvic floor and abdominal muscle cocontraction in women with and without pelvic floor dysfunction: a systematic review and meta-analysis

Giovana Vesentini,Regina El Dib,Leonardo Augusto Rachele Righesso,Fernanda Piculo,Gabriela Marini,Guilherme Augusto Rago Ferraz,Iracema De Mattos Paranhos Calderon,Angélica Mércia Pascon Barbosa,Marilza Vieira Cunha Rudge

doi:10.6061/clinics/2019/e1319

Abstract

There is an ongoing discussion regarding abdominal muscle (AbM) and pelvic floor muscle (PFM) synergism. Therefore, this study aimed to investigate the cocontraction between AbMs and PFMs in women with or without pelvic floor dysfunction (PFD). The following databases were searched up to December 21, 2018: MEDLINE, EMBASE, LILACS, PEDro and CENTRAL. We included any study that assessed the cocontraction between PFMs and AbMs in women with and without PFD. Two reviewers independently screened eligible articles and extracted data. The outcomes were extracted and analyzed as continuous variables with random effect models. Twenty studies were included. A meta-analysis did not show differences in women with and without PFD. However, a sensitivity analysis suggested cocontraction of the transversus abdominis (TrA) during PFM contraction in healthy women (standardized mean difference (SMD) –1.02 [95% confidence interval (CI) −1.90 to −0.14], P=0.02; I2= not applicable; very low quality of evidence). Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% CI 0.27 to 1.94], P=0.01; I2= not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], P<0.0001; I2 = not applicable; very low quality of evidence). Increased cocontraction of the TrA may be associated with maximal contraction of PFMs in women without PFD. On the other hand, there is likely an increased cocontraction with the OI and OE in women with PFD.

Highlights

Pelvic floor dysfunction (PFD) refers to a group of disturbances in the pelvic floor muscles (PFM) or connective tissues usually associated with pelvic organ prolapse, urinary and/or anal incontinence, sexual dysfunction, and pelvic pain (1)
Women with PFD during contraction of PFMs showed cocontraction of the obliquus internus (OI) (SMD 1.10 [95% confidence interval (CI) 0.27 to 1.94], P=0.01; I2= not applicable; very low quality of evidence), and obliquus externus (OE) (SMD 2.08 [95% CI 1.10 to 3.06], Po0.0001; I2 = not applicable; very low quality of evidence)
We investigate the coactivity of abdominal muscle (AbM) – transversus abdominis (TrA), rectus abdominis (RA), obliquus internus (OI), and obliquus externus (OE) – and PFMs in women with or without PFD

Summary

Introduction

Pelvic floor dysfunction (PFD) refers to a group of disturbances in the pelvic floor muscles (PFM) or connective tissues usually associated with pelvic organ prolapse, urinary and/or anal incontinence, sexual dysfunction, and pelvic pain (1). Treatment-related costs are estimated to correspond to an annual expenditure of 12 billion dollars and are projected to increase every year (2), with a considerable prevalence according to the population and definition used (3). No potential conflict of interest was reported. Received for publication on April 30, 2019. Accepted for publication on October 4, 2019

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